Very Cool Cartoon On Side Effects Of Proton Pump Inhibitors (PPI) For GERD

The skeptical cardiologist not uncommonly recommends OTC Prilosec (omeprazole), a proton pump inhibitor for cardiac patients with chest pain that is from acid reflux (GERD).
Lately, however, some studies have raised concerns about the long term side effects of taking PPIs.
I came across a very cool cartoon which reviews one patient’s history with respect to PPIs in today’s Annals of Internal Medicine.
I’ve been meaning to delve more deeply into the literature on PPI side effects but until then I think this cartoon does a great job of summarizing what patient’s should be considering.
You can view the entire cartoon for free on the Annals website here
Here is the first panel which describes a patient who has been taking the PPI pantoprazole for decades:

And this is the last panel
It’s ironic that at one point in this patient’s treatment he is put on Zantac (ranitidine). In recent weeks the FDA has issued warnings about a possible carcinogen in generic ranitidine and CVS and Walgreens have pulled it from their shelves.
Antirefluxively Yours,


6 thoughts on “Very Cool Cartoon On Side Effects Of Proton Pump Inhibitors (PPI) For GERD”

  1. The PPI omeprazole – in some circumstances, for some people – can have other unfortunate gastrointestinal effects than the one intended.
    Following my AF ablation a few years ago I was prescribed dabigatran (Pradaxa) and a double dose of omeprazole. After four days I unilaterally quit that combo due to the violent diarrhea that resulted. It was eventually diagnosed as lymphocytic colitis, one of the two “microscopic” colitii (plural?). It took a few months to resolve.
    Maybe it was one of those drugs, maybe the other – or the combo. The …zoles are noted for this. Dabigatran, noted for this as well, is formulated with tartaric acid to effect availability. Counterproductive in this circumstance? The reason for doubling the omeprazole?
    Neither possible trigger shall ever again pass my lips.
    I was given rivaroxaban instead.
    Fortunately, I escaped the rare but deadly atrio-esophageal fistula that this combo was prescribed to prevent. 🙂
    Sometimes ya just gotta make yer hard choices.

    • No. It is an H2 inhibitor like ranitidine but no potential carcinogen reports on it. And it is more potent than ranitidine.
      from a paper:
      Famotidine, an H2-receptor antagonist with a thiazole nucleus, is approximately 7.5 times more potent than ranitidine and 20 times more potent than cimetidine on an equimolar basis. Therapeutic trials indicate that famotidine 20 mg b.i.d. or 40 mg at bedtime is as effective as standard doses of cimetidine and ranitidine for healing duodenal ulcers. A dose of 40 mg at bedtime appears to heal benign gastric ulcers. A single nocturnal dose of 20 mg is effective in preventing duodenal ulcer relapse. Further studies are required that compare the efficacy of famotidine with cimetidine and ranitidine in the treatment of gastric ulcers and in the prevention of recurrent duodenal ulcers. The overall incidence of adverse effects observed with famotidine appears to be similar to that reported for cimetidine and ranitidine. Like ranitidine, famotidine does not have antiandrogenic effects or substantially inhibit the hepatic metabolism of drugs.

  2. The ranitidine vs PPIs has put me in a very bad spot. I’ve used ranitidine for years (I’ve had moderate/severe GERD forever) but finances force me to use a generic. I’ve used both prescription and OTC PPIs before but for some reason they cause me more pain than the acid. I’ve been using famotidine lately but it doesn’t seem to be doing much.

  3. Acid reflux can be treated more effectively by changes in diet – less coffee, alcohol, acidic foods – and weight reduction. Oh that’s diet too. If we have a big gut, a BMI above the safe range like 25, its likely we will develop GRDI. As someone who had that for decades, I found a cure – lose weight and stop drinking coffee etc.


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